S179 Enhancing Colonoscopy Outcomes: A Systematic Review of the Clinical Effectiveness of a Novel Rigidizing Overtube in Completing Difficult Colonoscopies and Achieving Complex Polyp Resection
Bibliographic record
Abstract
Introduction: Poor scope maneuverability and loop formation are some of the reasons for incomplete colonoscopies and suboptimal polyp resection even amongst expert endoscopists. The rigidizing overtube (RO) has been reported as a useful device used to overcome difficulties during colonoscopies and assisting in the completion of technically challenging procedures. In this study, we conducted a systematic review to assess the clinical success of using the RO to complete difficult colonoscopies and achieve complex polyp removal. Methods: We used multiple electronic databases from August 2019 through May 2023 to identify studies evaluating the use of the novel RO for colonoscopies. We followed the PRISMA guidelines. Quality/risk for bias was assessed using the Newcastle-Ottawa Scale (NOS). Results: Six studies were included; one study was divided into 2 different indications with a total of 165 patients (Figure 1). In the 3 studies that the indication was difficult to complete colonoscopies involving (53 patients), the colonoscopy completion rate was 88.7% (n = 47), the procedure facilitation was reported in 2/3 studies with a 93.1% (n = 27) and 100% (n = 9) respectively. Failure in these studies were reported in 2 patients due to anatomical restrictions and no adverse events were reported. One study compared polyp resection with and without the RO, reporting similar en-bloc resection and curative rates using RO (RO-ESD) when compared with conventional ESD (C-ESD), en-bloc resection success (RO-ESD 92% vs 96% C-ESD) and curative resection (RO-ESD 88% vs 92% C-ESD). In 2 studies that evaluated RO in the removal of complex polyps (62 patients), technical success was achieved 100% for both studies. One of the studies reported clinical success of 90% (n = 52), en-bloc resection of 86.4% and R0 resection of 80%, for both studies procedure facilitation ranged from 98.3-100%. None of these studies reported adverse events (Table 1). Conclusion: Our findings suggest that using RO shows promise in enhancing the clinical success of completing difficult colonoscopies and achieving successful ESD and EMR of colonic lesions by avoiding looping and offering stability. Further randomized studies evaluating the efficacy and cost of the RO are warranted.Figure 1.: PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources. Table 1. - General Characteristics of the Studies N Study AIM Study Type Age, mean (SD) Sex (Male) Overtube Indication Indication of Colonoscopy Change of endoscope Success Procedure Facilitation Wei et al. (2021) 29 Difficult Colonoscopies Case Series 66 (13.6) 18 (62.1%) Incomplete Colonoscopy (n = 12, 41.4%)Enhancing Insertion (n = 6, 20.7%)Stabilization during endoscopic Resection (n = 11, 37.9%) Screening (n = 3, 10.3%)Surveillance (n = 7, 24.1%)Recent large polyp (n = 10, 34.5%)IDA/GI Bleeding (n = 3, 10.3%)Recent Incomplete colonoscopy (n = 1, 3.4%) Pediatric Endoscope (n = 4 , 13.8%) Colonoscopy Completion, (n = 23, 79.3%) 27 (93.1) Park N. et al. (2022) 15 Difficult Colonoscopies Prospective descriptive 63.2 (18) NA Incomplete Colonoscopy (n = 15, 100%) Surveillance (n = 9, 60%)Recent large polyp (n = 3, 20%)Evaluation of Chron's Disease (n = 2, 13.3%)Other (n = 1, 6.7%) NA Colonoscopy Completion, (n = 15, 100%) NA Friedland (2020) 9 Difficult Colonoscopies Case Series NA NA Incomplete Colonoscopy (n = 7, 77.8%)Intraprocedure failed Colonoscopy (n = 2, 22.2%) Incomplete colonoscopy (n = 9, 100%) Pediatric colonoscope (n = 5, 55.5%)Longer enteroscope (n = 2, 22.2%) Colonoscopy Completion (n = 9, 100%) 100% Farha et al. (2022) 50 Polyp Resection (ESD) Retrospective MatchedStudy RO vs No RO 66.7 (12.1) 18 (72%) Polyp Resection using ESD (100%) Polyps (100%) NA En-bolc resection: RO-ESD 92% vs 96% C-ESDCurative Resection: RO-ESD 88% vs 92% NA Jawaid et al. (2023) 58 Challenging Polyp Removal Observational 67.6 (9.9) 28 (50%) 2 polypectomies in the cecum1 ascending colon mucosal resection1 cecal submucosal dissection Polyps (100%) Intervention changed: 6 (13.6%) Technical Success: 100%Clinical Success: 90%En-bolc resection: 86.4%R0 resection: 80% 98.30% Friedland (2020) 4 Challenging Polyp Removal Case Series NA NA Challenging Polyp Removal (100%) Polyps (100%) NA Technical Success: 100% 100%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.055 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.011 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".